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Between that and cultural differences over things like the dirty jokes, it's not too hard to see how France might give it one rating and then someone at the ESRB looked at the "PEGI 16" rating and said "well T is the closest thing to that, NEXT."
That said I would not call MOS a gory game by American gaming standards.
https://www.esrb.org/ratings/ratings_guide.aspx
Styx received a TEEN rating for "Violence, Blood, Sexual Themes, Language and Crude Humor".
That was me just trying to be funny, the censoring was intentional. I don't curse in real life.